Naming and Describing Services Chaplains Provide

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Naming and Describing ServicesChaplains Provide
Pre-conference Workshop March 11, 2006
NACC Columbus 2006

• Rev. Dean V. Marek
• Mayo Clinic, Rochester, MN
• marek.dean_at_mayo.edu

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Our Published Task

• Attendees will develop a catalogue of
  pastoral/spiritual care services to describe what
  chaplains do. They will also author clear
  definitions to explain the breadth and depth of
  the services we provide. This catalogue may
  become a standard reference for certifying
  organizations. This is a working workshop!

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Chaplains are often exhausted by the demands of
their daily work, yet unable to explain exactly
what they do or how they make a difference to
patients or to their organizations.
Father Gerald Broccolo, Health Progress Magazine,
March-April 2004.
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A Question

• What are the services that only chaplains can
  provide?
• What makes our contribution to the healthcare
  team unique?

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The Work Part I

• Four published works describing chaplain services
  were distributed to 34 participants
• CARE Manual, Mayo Clinic, 1999
• Spiritual Needs and Chaplaincy Services,
  Providence Health System, 2000
• Professional Chaplaincy, Larry VandeCreek and
  Laurel Burton, 2001
• Measures of Chaplain Performance and
  Productivity, Catholic Health Initiatives, 2002

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CARE PROGRAM (Chaplain Activity Record
Electronic) USERS MANUAL Department of Chaplain
Services Mayo Clinic, Rochester, MN June 10,
1999 Revised April 26, 2001 July 16,
2004 November 12, 2004 May 31, 2005
1999
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Service TypesDirect
AM Admit Home Visit Anointing Hospice
Home Care Anticipated Death Office Drop In
Bereavement Pastoral Contact Care
Conference Pre-surgical Contact Code 45
Public Worship Crisis Care Research
Intervention Death Retreat Care Group
Ethics Consult Coordination
Ritual/Sacrament Ethics Consult Scheduled
Spiritual Assessment Ethics Contact
Spiritual Care Family Care Staff Care
Funeral/Wake Staff Care Group Group
Facilitation Staff Development/Teaching
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Service TypesIndirect
Administration Mission Support CPE
Administration Preparation Time CPE
Meeting Professional Organization CPE
Preceptorship Research CPE Supervision Rounds CP
E Teaching Supervision Meeting Volunteer
Coordination
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2000
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2001
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PROFESSIONAL CHAPLAINCY Its Role and Importance
In HealthcareEditorsLarry VandeCreek
D.Min.Laurel Burton Th.D. DesignZGroupinc NYC
2001
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Chapter III

• When religious beliefs and practices are tightly
  interwoven with cultural contexts, chaplains
  constitute a powerful reminder of the healing,
  sustaining, guiding, and reconciling power of
  religious faith.
• 2. Professional chaplains reach across faith
  group boundaries and do not proselytize. Acting
  on behalf of their institutions, they also seek
  to protect patients from being confronted by
  other, unwelcome, forms of spiritual intrusion.

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• 3. They provide supportive spiritual care though
  empathic listening, demonstrating an
  understanding of persons in distress. Typical
  activities include
• Grief and loss care
• Risk screening identifying individuals whose
  religious/spiritual conflicts may
  compromise recovery or satisfactory adjustment
• Facilitation of spiritual issues related to
  organ/tissue donation
• Crisis intervention/Critical Incident Stress
  Debriefing
• Spiritual assessment
• Communication with caregivers
• Facilitation of staff communication
• Conflict resolution among staff members,
  patients, and family members
• Referral and linkage to internal and external
  resources
• Assistance with decision making and communication
  regarding decedent affairs
• Staff support relative to personal crises or work
  stress
• Institutional support during organizational
  change or crisis

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• 4. Professional chaplains serve as members of
  patient care teams by
• Participation in medical rounds and patient care
  conferences, offering perspectives on the
  spiritual status of patients
• Participation in interdisciplinary education
• Charting spiritual care interventions in medical
  charts
• 5. Professional chaplains design and lead
  religious ceremonies of worship and ritual such
  as
• Prayer, meditation, and reading of holy texts
• Worship and observance of holy days
• Blessings and sacraments
• Memorial services and funerals
• Rituals at the time of birth or other significant
  times of life cycle transition
• Holiday observances

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• 6. Professional chaplains lead or participate in
  healthcare ethics programs by
• Assisting patients and families in completing
  advance directives
• Clarifying value issues with patients, family
  members, staff and the organization
• Participating in Ethics Committees and
  Institutional Review Boards
• Consulting with staff and patients about
  ethical concerns
• Pointing to human value aspects of
  institutional policies and behaviors
• Conducting in-service education
• 7. Professional chaplains educate the healthcare
  team and community regarding the relationship of
  religious and spiritual issues to institutional
  services in the following ways Interpreting and
  analyzing multi-faith and multi-cultural
  traditions as they impact clinical services
• Making presentations concerning spirituality
  and health issues
• Training of community religious
  representatives regarding the institutional
  procedures for effective visitation
• Training and supervising volunteers from
  religious communities who can provide
  spiritual care to the sick
• Conducting professional clinical education
  programs for seminarians, clergy, and religious
  leaders
• Developing congregational health ministries
• Educating students in the healthcare
  professions regarding the interface of religion
  and spirituality with medical care

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• 8. Professional chaplains act as mediator and
  reconciler, functioning in the following ways for
  those who need a voice in the healthcare system
• As advocates or "cultural brokers" between
  institutions and patients, family members, and
  staff
• Clarifying and interpreting institutional
  policies to patients, community clergy, and
  religious organizations
• Offering patients, family members and staff an
  emotionally and spiritually "safe" professional
  from whom they can seek counsel or guidance
• Representing community issues and concerns to the
  organization
• 9. Professional chaplains may serve as contact
  persons to arrange assessment for the
  appropriateness and coordination of complementary
  therapies. Patients increasingly demonstrate
  interest in healing from many sources not
  represented within the traditional healthcare
  disciplines. Many of these complementary healing
  traditions are grounded in the worlds religious
  traditions and chaplains may utilize or make a
  referral for complementary therapies such as
• Guided imagery/relaxation training
• Meditation
• Music therapy
• Healing touch

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• 10. Professional chaplains and their certifying
  organizations encourage and support research
  activities to assess the effectiveness of
  providing spiritual care. While many chaplains
  serve in settings with little interest in
  conducting research, others are employed by
  centers with a research mission. Increasingly,
  chaplains attend to research in the following
  ways
• Developing spiritual assessment and spiritual
  risk screening tools
• Developing tools for benchmarking productivity
  and staffing patterns that seek to increase
  patient and family satisfaction
• Conducting interdisciplinary research with
  investigators in allied fields, publishing
  results in medical, psychological, and
  chaplaincy journals
• Promoting research in spiritual care at national
  convention

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2002
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Digging Deeper

• What are the services that only chaplains can
  provide?
• What makes our contribution to the healthcare
  team unique?

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The Work - Part I

• In groups of four we
• examined the various published descriptions of
  services that chaplains provide
• eliminated generic services, i.e., those services
  that other non-certified, non-chaplains can
  provide
• agreed on those services that are unique to
  chaplains
• wrote each service type on its own post-it note
  (51 service were noted)
• collated the 51 notes into 16 unique categories

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Generic Services
There are some services that some chaplains
provide that other non-chaplains could well
perform, thus releasing the chaplain for those
services that are sui generis to the profession.

• As it contained the most comprehensive listing of
  chaplain activities, we looked again at
  Professional Chaplaincy Chapter III to determine
  which activities were unique to chaplains, i.e.,
  what services only chaplains could provide -

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• Grief and loss care
• Risk screening identifying individuals whose
  religious/spiritual conflicts may compromise
  recovery or satisfactory adjustment
• Facilitate spiritual issues related to
  organ/tissue donation
• Crisis intervention/Critical Incident Stress
  Debriefing
• Spiritual assessment (some thought this is only
  the chaplains to do)
• Communication with caregivers
• Facilitate staff communication
• Conflict resolution among staff members,
  patients, and family members
• Referral and linkage to internal and external
  resources
• Assist with decision making and communication
  regarding decedent affairs
• Staff support relative to personal crises or work
  stress
• Institutional support during organizational
  change or crisis

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• Participate in medical rounds and patient care
  conferences, offering perspectives on the
  spiritual status of patients
• Participate in interdisciplinary education (if
  about religious issues)
• Chart spiritual care interventions in medical
  charts
• Assist patients and families in completing
  advance directives
• Clarify value issues with patients, family
  members, staff and the organization
• Participate in Ethics Committees and
  Institutional Review Boards
• Consult with staff and patients about ethical
  concerns
• Point to human value aspects of institutional
  policies and behaviors
• Conduct in-service ethics education

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• Act as advocates or "cultural brokers" between
  institutions and patients, family members, and
  staff
• Clarify and interpret institutional policies to
  patients, community clergy, and religious
  organizations
• Offer patients, family members and staff an
  emotionally and spiritually "safe" professional
  from whom they can seek counsel or guidance
• Represent community issues and concerns to the
  organization
• Chaplains may utilize or make a referral for
  complementary therapies such as
• Guided imagery/relaxation training
• Meditation
• Music therapy
• Healing touch

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• Chaplains attend to research in the following
  ways
• Developing spiritual assessment and spiritual
  risk screening tools
• Developing tools for benchmarking productivity
  and staffing patterns that seek to increase
  patient and family satisfaction
• Conducting interdisciplinary research with
  investigators in allied fields, publishing
  results in medical, psychological, and chaplaincy
  journals
• Promoting research in spiritual care at national
  convention

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Whats Left?

• The following services were considered especially
  suited to chaplains because of an implicit or
  explicit reference to religion and/or
  spirituality and because of the specific
  competencies necessary to carry them out.

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Chapter III
2. Professional chaplains reach across faith
group boundaries and do not proselytize. Acting
on behalf of their institutions, they also seek
to protect patients from being confronted by
other, unwelcome, forms of spiritual intrusion.
32

• 5. Professional chaplains design and lead
  religious ceremonies of worship and ritual such
  as
• Prayer, meditation, and reading of holy texts
• Worship and observance of holy days
• Blessings and sacraments
• Memorial services and funerals
• Rituals at the time of birth or other significant
  times of life cycle transition
• Holiday observances

33

• 7. Professional chaplains educate the healthcare
  team and community
• Interpreting and analyzing multi-faith and
  multi-cultural traditions as they impact clinical
  services
• Making presentations re spirituality and health
  issues
• Training of community religious representatives
  regarding the institutional procedures for
  effective visitation
• Training and supervising volunteers
• Conducting professional clinical education
  programs for seminarians, clergy, and religious
  leaders
• Developing congregational health ministries
• Educating students in the healthcare professions
  regarding the interface of religion and
  spirituality with medical care

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The Work - Part II

• After lunch dyads were formed and participants
  were instructed to
• chose one of the 16 categories and write a clear
  concise description of the service
• name the skills/competencies necessary to
  accomplish the service
• separate the service provided from the skills
  needed to provide the service

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The 16 Service Types(In Alphabetical Order)

• The number of hits associated with each
  category represents the number of times the
  service was mentioned in the Part I

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1. Advocacy 1 Hit

• Chaplains are a voice for the voiceless,
  vulnerable, and persons at risk
• Editorial comment
• Advocacy may be viewed as a skill to facilitate
  appropriate services for patient care

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2. Charting Spiritual Care 1 Hit

• Record a clear and concise summary of the
  patients spiritual concerns, how they have been
  addressed, and the plan of care
• Communicate necessary information to the
  interdisciplinary team
• Comment
• Charting is an institutional imperative
• Bullet 2 would view it as communication for the
  sake of collaboration, and thus indirect service
  for patient care

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3. Continuing Education 3 Hits

• Professional development and maintenance of
  credentials for ministry
• Comment
• The writers wanted to see that the experience
  gained in ministry would also be shared with
  others
• This, then, would be categorized under Education

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4. Ethics Facilitation 2 Hits

• Promote competent ethical reflection and decision
  making
• Comment
• May be viewed as a skill in service of the
  patient
• May also be categorized as Spiritual Intervention

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5. Education 12 Hits

• Interpretation of the interface between
  spirituality and health for the institution and
  community
• Comment
• Recipients include patients, families, staff,
  residents, students, parish nurses,
  congregational health ministries, volunteers,
  etc.
• Venues include employee orientation, CPE,
  continuing education, churches, Pastoral Care
  Week, etc.

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6. End of Life Care 1 Hit

• Pastoral care at the time of loss, grave or
  terminal diagnosis, withdrawal of life support,
  fetal demise, and sudden death
• Comment
• This may be categorized as Spiritual Intervention
• However, EOL Care it may stand on its own as a
  major ministry in Hospice and because of the
  nature of the population we serve

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7. Interpret Religious Diversity and Spiritual
Practices 1 Hit

• Interpret the spiritual/religious teachings and
  practices of a diverse patient population as they
  impact an individual need
• Comment
• This is a skill that may be part of a Spiritual
  Intervention
• It is Education in that it informs staff of
  unfamiliar religious practices

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8. Ministry of Presence 1 Hit

• Assist those served to access their spirituality
  as part of the healing process
• Comment
• The ministry of presence may encompass a variety
  of skills that are invoked by the chaplain to
  release the spiritual power of the patient and
  facilitate the healing process
• It is a skill set in the chaplains tool kit

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9. Networking 1 Hit

• Connect community faith resources to particular
  patient spiritual needs
• Comment
• Networking is a process that results in
  collaboration for patient care
• As such it is an indirect service that
  facilitates a Spiritual Intervention

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10. Pastoral Presence 1 Hit

• Ministry to a patient from an initial meeting
  with a spiritual assessment through appropriate
  spiritual interventions , follow-up ministry, and
  dismissal
• Comment
• Pastoral presence, similar to the ministry of
  presence, encompasses a variety of spiritual
  interventions that are facilitated by the
  chaplain to release the spiritual power of the
  patient
• It is an attitude more than a specific service

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11. Prayer and Meditation 4 Hits

• Attention to the patients condition reflecting
  the concerns of the patient providing comfort and
  reassurance
• Comment
• Prayer is often viewed as something done by the
  chaplain for the patient, Ill pray for you,
  rather than a sacred/spiritual dialogue that
  facilitates the patients journey to his/her soul
  wherein lies the primary source of spiritual
  power
• Prayer is a tool in the chaplains kit that may
  or may not be a part of every Spiritual
  Intervention

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12. Religious and MoralGuidance - 1 Hit

• Caring for the soul of the institution, the
  chaplain provides religious and moral guidance to
  the system, administration, employees, and
  medical staff
• Comment
• The chaplain is a facilitator of spiritual care.
  This category may better be included under
  Spiritual Intervention

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13. Rituals 13 Hits

• Celebration of symbolic acts of the community of
  faith, which provide meaning to the experience of
  illness, suffering, and loss
• Comment
• The number of hits would indicate that ritual
  practices are a large part of the services
  chaplains provide
• See next slide for an enumeration of services
  mentioned

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13. Rituals 13 Hits

• Anointing with oil
• Blessings
• Creating situation specific rituals (2x)
• Leading reflections
• Memorial services (x2)
• Religious services
• Rituals at birth and other significant times
• Sacraments
• Worship services (x3)

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14. Spiritual/Religious Assessment - 6 Hits

• Discern and understand patients spiritual needs
  and concerns in light of their current health
  issues
• Comment
• A chaplains spiritual assessment is often done
  informally in hospital, given the short length of
  stay, and informs all spiritual interventions at
  the point of delivery
• All participants believe that the professional
  chaplain is most qualified to make an accurate
  spiritual assessment

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15. Spiritual Intervention 6 Hits

• Response of the community of faith to the
  assessed spiritual needs and concerns of the
  patient to find meaning in the experience of
  illness and facilitate the process of spiritual
  healing
• Comment
• It is evident that several of the services
  already mentioned would better fit in this
  category
• A more suitable term than intervention might be
  chosen to highlight the sacred nature of our care
  (cura animarum care of souls)

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15. Spiritual Interventions (Care)

• Crisis Care
• Life Review
• Sacred Stories
• Support
• Sp. Counsel/Direction
• Advocacy
• End of Life Care
• Ethics Consult
• Interpret Rel Diversity and Practice

• Networking
• Prayer/Meditation
• Religious/Moral Guidance
• Spiritual Assessment
• Theological Reflection
• Rituals
• Not mentioned
• Bereavement Care
• Family Care
• Staff Care

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16. Theological Reflection - Sensitivity to
Diversity 2 Hits

• Facilitates a patients ability in bringing faith
  to his or her current experience
• Comment
• This, too, may be a Spiritual Intervention, as
  the chaplain facilitates the spiritual work of
  the patient.

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Summary by Hits

• 13 Rituals
• 12 Education
• 6 Spiritual Assessment
• 6 Spiritual Intervention
• 4 Prayer/Meditation
• 3 Continuing Ed
• 2 Ethics Reflection
• 2 Theological Reflection

• 1 Each
• Advocacy
• Charting
• End of Life Care
• Interpreting Religious Diversity
• Ministry of Presence
• Networking
• Pastoral Presence
• Religious Guidance

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The Chaplains Tool Kit
What are the tools/skills that we bring with us
when providing pastoral/spiritual care?
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Tools/Skills

• Non-anxious Presence
• Non-judgmental Acceptance
• Respect for Diversity
• Solidarity with the Vulnerable
• Ability to Listen
• Compassion
• Empathy
• Self-awareness
• Developed Intuition
• Professional Boundaries
• Relational/Comm Skills
• Comfort with Silence

• Gift of Time
• Theological Education
• Ability to Reflect Theologically
• Spiritual Knowledge
• Religious Knowledge
• Shared Spiritual Power
• Denominational Endorsement
• Pastoral Authority
• Prayer, Rituals, and Sacraments
• Discernment
• Self Esteem
• Ability to Assess Spiritually

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The Work - Part II

• We also examined the NACC competencies for
  certification to name any that are generic
• The group agreed that the competencies must
  remain intact as the necessary heart and
  foundation for all chaplain services
• Personal
• Theological
• Professional
• No one category could stand alone as more
  important than the others

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Continuing Education
Charting
Ethics Facilitation
Advocacy
Education
Theological Reflection
End of Life Care
Spiritual Intervention
COMPETENCIES
Interpret Religious Diversity
Spiritual Assessment
Ministry of Presence
Rituals
Religious Guidance
Pastoral Presence
Prayer Meditation
Networking
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The Next Step

• The pre-conference workshop participants will be
  asked by email to review again the 16 categories
  and offer suggestions to further delineate (add
  or subtract) the services unique to chaplains

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The Afternoon Session

• Participants were asked to name for themselves
  those services that were unique to a chaplain by
  reason of profession and competencies
• Results were shared at each table
• Each table agreed upon one list of services as
  unique to chaplains
• The results will be collated and compared with
  the work of the pre-conference workshop and
  posted on www.nacc.org at a later date

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The Beginning